This information is about a chemotherapy treatment for bladder cancer called Carbo MV. It describes the drugs, how they are given and some of the possible side effects. If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer information nurse specialists.

Carbo MV is named after the chemotherapy drugs used, which are:

• carboplatin
• methotrexate 
• vinblastine.

Carbo MV treatment can usually be given to you as a day patient. You will need to have a blood test before you start treatment - either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All this may take a couple of hours.

The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it shouldn't take long. Some people have their chemotherapy given through a thin plastic tube which is inserted under the skin into a vein near the collarbone (central line) or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.

Before you are given the chemotherapy you will be given some anti-sickness (antiemetic) drugs. These are usually given by injection through your cannula, central line or PICC line, which is connected to a drip (infusion).

The chemotherapy drugs are given separately:

• vinblastine (a colourless fluid) is given as an infusion into your cannula or line over about 5–10 minutes
• methotrexate (a yellow fluid) is given as an injection along with a drip of salt water (saline) into your cannula or line
• carboplatin (a colourless fluid) is given as an infusion into your cannula or line over about an hour.

Once treatment is finished you can go home, and the cannula will be removed before you go. If you have a central or PICC line, it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line.

You will be given a supply of anti-sickness drugs to take home with you. It's important to take these as directed even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.

Your doctor may use the word regimen (eg the Carbo MV regimen) when talking about your chemotherapy. This means the whole plan or schedule of your particular chemotherapy treatment. The following is a description of a commonly-used regimen for giving Carbo MV.

On the first day of your treatment you will be given all three chemotherapy drugs (carboplatin, methotrexate and vinblastine) as described above. Two weeks later (day 15) you will be given the methotrexate and vinblastine again. After another week (day 22) the same two drugs are given again.

After this, you will have a rest period with no chemotherapy for another week. This completes a cycle of your treatment. Each cycle takes four weeks (28 days).

Following the rest period, the same drugs will be given to you again, beginning the next cycle of your treatment. Usually six cycles of treatment are given over six months. This makes up a complete course of treatment.

Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is having Carbo MV chemotherapy.

We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to to affect you. If you notice any effects that you think may be due to the drug, but which are not listed here, please let your nurse or doctor know. There may be simple changes to the way the chemotherapy is given that will reduce the side effects without reducing its effectiveness.

Lowered resistance to infection Carbo MV can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your white blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straight away if:

• your temperature goes above 38ºC (100.4ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has recovered. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Bruising or bleeding Carbo MV can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with Carbo MV you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Feeling sick (nausea) and being sick (vomiting) There are very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor. They can prescribe other anti-sickness drugs, which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness Many people feel extremely tired during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.

Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.

Taste changes You may notice that your food tastes different. Normal taste will return when treatment ends.

Hair loss Complete hair loss is uncommon with Carbo MV chemotherapy, but you may find that some of your hair falls out. If this happens it will be temporary and your hair will start to grow again once treatment is finished.

Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it is available at your hospital.

Numbness or tingling in the hands and feet Tell your doctor if you notice any numbness or tingling in your hands or feet. This is due to the effects of the carboplatin and vinblastine on the nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons, or other fiddly tasks. This usually improves slowly in the few months after the treatment ends.

Your kidney function may be affected Usually the effect on the kidneys is mild and it will not cause any symptoms, but if it is severe the kidneys can be permanently damaged unless the treatment is stopped. For this reason, your kidneys will be checked with a blood test before each treatment.

You will be asked to drink more than normal during the day after treatment. It is important to tell your doctor or chemotherapy nurse if you are not able to drink enough. Let your doctor or nurse know if you are not passing as much urine as normal.

Constipation It may help to drink plenty of fluids, eat a high-fibre diet and take gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor.

Sensitivity of the skin to sunlight During treatment with methotrexate, and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily than normal. You can still go out in the sun, but always wear a high-protection suncream and protective clothing and a hat.

Skin changes Methotrexate can cause a rash, which may be itchy. Your doctor can prescribe medicine to help. Areas of skin that have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens.

Your liver may be temporarily affected Methotrexate may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. This is unlikely to cause you any harm but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver function.

Allergic reaction You will be monitored for any signs of an allergic reaction during the treatment. Signs include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, headache, breathlessness, anxiety and a need to pass urine. Tell your doctor or nurse if you have any of these signs, as medicine can be given to reduce them.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy can increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straight away if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines can be harmful to take when you are having chemotherapy (including those you can buy in a shop or chemist). Let your doctor know about any medicine you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by this treatment. It's important to discuss fertility with your doctor before starting treatment.

Contraception It's not advisable to become pregnant or father a child while being treated with Carbo MV chemotherapy as it may harm the developing foetus. It is important to use effective contraception during treatment, and for some time afterwards. Again discuss this with your doctor.

Loss of periods Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and may eventually stop. In younger women this may be temporary, but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.

This section is based upon our Carbo MV chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
• The Chemotherapy Source Book (4th edition). Ed. Perry. Lippincott Williams and Wilkins, 2007.

For further references, please see the general bibliography.